ADTnorm: Robust Integration of Single-cell Protein Measurement across CITE-seq Datasets

CITE-seq enables paired measurement of surface protein and mRNA expression in single cells using antibodies conjugated to oligonucleotide tags. Due to the high copy number of surface protein molecules, sequencing antibody-derived tags (ADTs) allows for robust protein detection, improving cell-type identification. However, variability in antibody staining leads to batch effects in the ADT expression, obscuring biological variation, reducing interpretability, and obstructing cross-study analyses. Here, we present ADTnorm (https://github.com/yezhengSTAT/ADTnorm), a normalization and integration method designed explicitly for ADT abundance. Benchmarking against 14 existing scaling and normalization methods, we show that ADTnorm accurately aligns populations with negative- and positive-expression of surface protein markers across 13 public datasets, effectively removing technical variation across batches and improving cell-type separation. ADTnorm enables efficient integration of public CITE-seq datasets, each with unique experimental designs, paving the way for atlas-level analyses. Beyond normalization, ADTnorm includes built-in utilities to aid in automated threshold-gating as well as assessment of antibody staining quality for titration optimization and antibody panel selection. Applying ADTnorm to a published COVID-19 CITE-seq dataset allowed for identifying previously undetected disease-associated markers, illustrating a broad utility in biological applications.


Main
Recent advances in single-cell multimodal profiling, such as Cellular Indexing of Transcriptomes and Epitopes by sequencing (CITE-seq), have enabled the paired profiling of gene expression alongside surface protein expression [1][2][3][4] .This paired multimodal profiling of single cells has allowed researchers to achieve more precise cell-type annotation (e.g., of immune cells) 5,6 , study the relationship between transcriptomic state and surface phenotype [7][8][9] , and readily adapt results to flow cytometry for validation 1,4 .Given its extraordinary potential, there is increasing application of CITE-seq for atlas construction [10][11][12] and in large cohort diseaserelated studies [13][14][15] .To effectively leverage the data being generated, there is a pressing need for computational tools for CITE-seq data integration across studies.
Surface proteome profiling by CITE-seq gives rise to specific data characteristics and sources of technical noise inherent to antibody staining.Owing to the high copy number of surface proteins and efficient molecular capture of antibody-derived tags (ADTs), protein expression is considerably less sparse than other single-cell modalities such as mRNA expression or genome-wide chromatin accessibility.Consequently, the protein expression captured by CITE-seq often closely matches the information-rich multi-peak density distributions observed in flow cytometry 1 (Supplementary Fig. 1A).Density distributions of protein expression of CITE-seq data frequently exhibit a negative peak, representing background signal arising from non-specifically bound or unbound (free-floating) antibody 16 , and one or more positive peak(s) representing cells expressing the target protein.Similar to fluorescence-based techniques, the signal-to-noise ratio between the negative-and positive-expression peak(s) is highly sensitive to antibody staining conditions, including antibody concentrations 17 , staining volumes and time 18 , and antibody panel composition 19 .Because of these unique considerations, the normalization and integration approaches devised for other single-cell modalities may not be directly translatable, highlighting the need for methodologies tailored to the intricacies of protein data.
Recent normalization algorithms designed for CITE-seq data, similar to established scRNA-seq approaches 20,21 , have primarily focused on modeling sequencing bias and ambient expression to remove background signals.Centered log-ratio (CLR) normalization was initially proposed for CITE-seq 1 , using library size to account for variable sequencing depth and cell size.However, unlike scRNA-seq, which offers relatively unbiased transcriptional profiling, CITE-seq protein panels target only a handful of manually selected proteins, typically between 10 and 300.Therefore, the overall ADT library size is highly sensitive to panel composition, can be easily skewed by high expression of a few subset-specific proteins, and unreliably reflects sequencing depth or cell size.More sophisticated algorithms, including totalVI 22 , DSB 16 , and DecontPro 23 , attempt to model ambient contamination and remove or re-center the background-signal to zero.However, these negative-expression peaks in ADT abundance mirror expression distributions by conventional cytometry and are essential for reliable threshold-gating of cells for cell-type annotation 24 .Improper or incomplete removal of background ADT expression can make it difficult to distinguish between negative-, mid-, and high-expression peaks, for example, in the trimodal expression of the surface marker CD4, a T cell lineage marker.Consequently, normalization of the negative peak in CITE-seq should emphasize its essential role in cell-type identification rather than its artificial removal.
Instead of individually modeling each source of noise, we constructed a non-parametric strategy, ADTnorm, building on methods originally conceived for cytometry data 25 to remove the batch effects through strategic peak identification and alignment.ADTnorm uses a curve registration algorithm 26 to identify protein density landmarks, including the negative and positive peaks, and relies on local minima to detect the valleys separating adjacent peaks.Employing a functional data analysis approach 27 , ADTnorm normalizes protein expression by aligning the landmarks across datasets (Fig. 1A and Methods), effectively simulating a scenario where all data are derived from the same experiment with equivalent background and antibody staining quality.ADTnorm is implemented as an R package (https://github.com/yezhengSTAT/ADTnorm)with an interactive graphical user interface to simplify landmark adjustments (Supplementary Fig. 1B) and a Python wrapper (https://github.com/donnafarberlab/ADTnormPy)available to facilitate ADTnorm's integration into existing CITE-seq analysis workflows (Supplementary Note).
Leveraging 13 public CITE-seq datasets (Supplementary Table 1), we benchmarked the integration performance of ADTnorm against 14 methods from three broad groups: (1) scaling methods commonly applied to cytometry and single-cell data, including Arcsinh transformation, CLR 1 , log-transformation of count per million (logCPM), and a hybrid approach combining Arcsinh and CLR transformations (Arcsinh + CLR); (2) popular single-cell batch effect removal tools, including Harmony 28 implemented on the raw counts, arcsinh-transformed, CLR-transformed or logCPM-transformed data, fastMNN 29 , and CytofRUV 30 ; and (3) methods tailored to CITE-seq normalization, including DSB 16 , decontPro 23 , totalVI 22 , and sciPENN 8 .Across 13 datasets, ADTnorm effectively reduced batch variability, such that negative and positive populations for each surface protein marker could be consistently identified across studies (Fig. 1B, protein density distributions in Supplementary Note).UMAP embeddings of the normalized ADT expression revealed effective batch integration by ADTnorm while preserving cell type separation at both broad and refined annotation levels, treating either the study-level or individual samples as batches (Supplementary Figs.2-3).ADTnorm applied using default landmark detection (default) or manually adjusted landmark detection (customized; Methods) outperformed other tools in balancing cell-type separation with cross-study batch effect removal as quantified by Silhouette scores, Adjust Rand Index (ARI), and the Local Inverse Simposon's Index (LISI) (Methods; Fig. 1C and Supplementary Fig. 4A-C).Furthermore, ADTnorm can facilitate the seamless integration of new datasets without reprocessing existing ones by aligning landmarks to predetermined locations (Supplementary Note).It can also incorporate users' prior knowledge about a batch's cell type composition.For example, because the Buus 2021 T cell dataset is composed of only T cells, ADTnorm is adjusted to align the singular peak in CD3 as positive-expression (Fig. 1B and Supplementary Note).ADTnorm is also highly scalable, with a fast processing speed and low memory consumption compared to other methods (Supplementary Fig. 4D-E).Also, ADTnorm is designed to process protein markers independently, allowing adaption to parallel processing.
We next explored the downstream impact of protein normalization on joint embeddings of RNA and protein data.Following batch-correction of ADT expression by the above methods and batch-correction of the RNA expression using reciprocal PCA 10 , we computed the multimodal embedding using the weighted nearest neighbor (WNN) algorithm 10 (Supplementary Fig. 5A and Methods).As totalVI and sciPENN already incorporate gene expression into their protein normalization process, we omitted them from the WNN integration comparison.As expected, methods with sub-optimal removal of ADT batch effects resulted in skewed WNN integration (Supplementary Fig. 6).ADTnorm markedly minimized batch influences and achieved superior accuracy in segregating cell types as quantified by ARI (Supplementary Fig. 5B), underscoring its utility in post-normalization multimodal integration.
As surface protein expression varies across cell types, batch correction may be sensitive to variable subset composition across batches.To evaluate the resilience of normalization methods, we subsampled specific cell subsets from a few batches, devising three scenarios featuring increasingly skewed cell-type compositions (Methods).Careful examination revealed that Harmony, fastMNN, and CytofRUV were highly sensitive to compositional differences, producing unexpected and inaccurate results.For example, CD19 is a highly specific B cell-lineage marker.However, in some batches, Harmony-and fastMNN-normalized CD19 expression was significantly higher in CD4 T cells than in CD8 T cells, and CytofRUV-normalized CD19 expression in CD8 T cells was comparable to that in B cells, patterns not supported by biological expectations (Fig. 1D and Supplementary Fig. 7).Similar discrepancies were noted with DSB, totalVI, and sciPENN across other vital lineage markers (Supplementary Figs.8-9).ADTnorm distinguishes itself by meticulously preserving the ranking of protein expression across cells within each batch, thereby reducing the risk of biologically irrelevant anomalies.
Beyond its primary role in batch correction, ADTnorm leverages intermediate landmark detection results to perform automated threshold-gating (auto-gating) for cell type annotation and to assess staining quality to aid in the optimization of CITE-seq experiments (Methods).
Valley landmarks identified during ADTnorm normalization can be used to perform automated cell type annotation using predefined gating rules (Supplementary Table 2; Supplementary Fig. 10A-C).While ADTnorm auto-gating showcased high accuracy for a majority of the studies, achieving between 80-100% for comprehensive and nuanced cell type distinctions, autogating was underperformed for dendritic cells, memory CD4 T and memory CD8 T cells in the Hao 2020, Kotliarov 2020, and Witkowski 2020 datasets (Fig. 1E).Auto-gating accuracy is likely influenced by the marker staining quality.Hence, we introduced a stain quality score, inspired by fluorescent stain index 31 , to detect protein markers with poor signal-to-noise separation (Methods; Supplementary Fig. 1C).Low-quality scores are suggestive of under-optimized staining conditions, which need careful evaluation or potential exclusion from downstream analyses.Leveraging ADTnorm to assess staining quality revealed that CD56 and CD45RA, which are markers used for gating dendritic and memory T cells, featured less distinct peak separation in batches with poor auto-gating performance (Fig. 1F and Supplementary Fig. 10D).
To effectively stain for surface protein, antibody concentrations must be carefully tuned for each sample type.Sufficient antibodies are essential for positive-expression signal(s) to overcome background, but an overabundance of antibodies can obscure rare or low-expression markers by increasing background noise and can increase experimental costs.Although downstream analysis can often tolerate suboptimal staining conditions, variable staining quality is a major source of batch artifacts across samples and laboratories.To explore whether our stain quality score is sensitive enough for titration optimization and to evaluate ADTnorm's ability to mitigate these batch effects, we utilized a titration CITE-seq study that analyzed 124 antibodies on human peripheral blood mononuclear cells (PBMCs) 17 .This study categorized antibody titration into four levels, including the manufacturer's recommended concentration (1x) and adjustments to 1/25x, 1/5x, and double (2x) the recommended concentration.As anticipated, the higher concentrations (1x and 2x) typically yielded more distinct separation between negative and positive cell populations, whereas lower concentrations led to greater overlap between negative and positive populations or failed to identify any positive population (Fig. 2A and Supplementary Note).These trends were reflected in the stain quality scores, where markers with reduced separation at low antibody concentrations exhibited lower scores (Fig. 2B).Notably, conventional normalization methods were unable to successfully integrate expression across titration batches (Supplementary Fig. 11 and Supplementary Note), but ADTnorm could effectively align negative and positive populations across concentrations, thus rescuing cell type discrimination for many protein markers profiled using sub-optimal staining conditions (Supplementary Fig. 12) and minimizing batch effects (Fig. 2A).For markers at low titrations that exhibited no positive population, ADTnorm could only align the negative populations (Supplementary Fig. 13A).In these cases, excessively low stain quality scores could alert researchers of protein markers that consistently show poor discrimination, suggesting a potential need for revising antibody titration or selection (Fig. 2B and Supplementary Fig. 13B).We also assessed the influence of antibody titration on ADTnorm's auto-gating accuracy, finding that auto-gating accuracy remains stable as long as lineage markers had detectable positive staining (Supplementary Fig. 14).
We next explored whether ADTnorm could facilitate the analysis of consortium efforts.
Three UK medical centers profiled 192 protein markers using CITE-seq to study COVID-19 immune response across a diverse cohort of over 100 healthy donors and COVID-19 patients 13 .
Staining quality was highly variable across the participating medical centers (Fig. 2C).Specifically, samples from Newcastle (Ncl) exhibited reduced separation between negative and positive peaks, whereas samples from Cambridge and Sanger displayed robust separation and a higher frequency of detectable positive signals (Supplementary Figs.15-16).These batch effects could not be effectively mitigated by other tools (Fig. 2C, Supplementary Fig. 17 and Supplementary Note).ADTnorm effectively reduced technical artifacts (Fig. 2C), resulting in improved cell type separation, both at the broad and refined annotation levels and also in the joint RNA and ADT embedding (Supplementary Fig. 18).Leveraging ADTnorm's integration and auto-gating, we next aimed to identify whether the expression of specific surface markers could be associated with COVID-19 disease (Supplementary Fig. 16E).Previous studies have identified compositional changes in the immune compartment associated with disease, including increases in the frequency of specific monocyte subsets in the PBMC compartment of mild, moderate, and severe COVID-19 patients (as noted in Fig. 1c of the original publication 13 ).Other studies have identified biomarkers on blood monocytes associated with COVID-19 and type-I interferon signaling, including CD38 32,33 , CD64 34,35 and CD169 36,37 .We sought to identify whether these trends could be attributed to changing subset frequencies within the monocyte compartment or to the upregulation of these markers across multiple subsets of monocytes.We analyzed the percent-positivity of these and other markers on CD14 + , CD16 + , and CD83 + CD14 + monocytes, and observed upregulation of these markers among COVID-19 patients compared to healthy donors across multiple monocytes states (Fig. 2D-E and Supplementary Fig. 19A).Such upregulation mirrors the trends observed in scRNA-seq (Supplementary Fig. 19B).The normalization employed in the original publication, DSB, did not accurately represent these trends, masking positive expression of CD169 (Supplementary Fig. 20), failing to identify upregulation of CD169 with COVID-19 in any monocyte subset, and reducing signal of CD38 and CD64 in CD16 monocytes (Supplementary Fig. 19C).This demonstrates the utility of ADTnorm in isolating biologically relevant changes and uncovering previously concealed insights in surface protein expression.
In summary, ADTnorm offers a fast, precise, and scalable solution for normalizing protein expression data, effectively minimizing batch artifacts within studies and enabling integration across studies.ADTnorm is designed for high adaptability, allowing for normalization at various batch levels, supporting missing data, and incorporating prior cell type knowledge.
By addressing protein batch effects, ADTnorm also improves multimodal aggregation of RNA and protein modalities, enhancing cell type discrimination and improving interpretability.Unlike other normalization methods that may introduce abnormal expression artifacts, ADTnorm maintains the ranked order of cells within batches for expression of each protein marker and delivers consistent performance across datasets with uneven cell type compositions.Additionally, its auto-gating feature offers an expedited avenue for cell-type annotation.The integrated stain quality scoring system alerts researchers to suboptimal staining and assesses experiment quality, aiding in the calibration of antibody titration for pilot studies tailored to specific tissue systems.Among positive-expressing populations, ADTnorm's landmark registration approach homogenizes variations in enrichment strength across samples.While it is possible that these variations represent biological differences, that interpretation is confounded by many sources of technical noise, including antibody concentrations, staining conditions, and sequencing artifacts.Notably, ADTnorm also preserves information about the proportion of positiveexpressing events in each batch, offering valuable insights into disease status, as exemplified in the COVID-19 case study.This feature underscores the potential of ADTnorm to transcend mere normalization, contributing to the identification of disease-associated protein markers.
Due to ADTnorm's high adaptability, we expect its utility may also extend beyond CITEseq, allowing for the harmonization of protein expression across multiple technologies (e.g., flow cytometry, CyTOF, and CITE-seq together).Its application is also primed for expansion to multimodal assays by leveraging the normalized protein data as a bridge for cross-modality integration, such as scCUT&Tag-pro 38 , ASAP-seq 39 and PHAGE-ATAC 40 , which profile surface proteins alongside epigenomic or chromatin accessibility features.ADTnorm stands as a pivotal tool in the evolving landscape of genomic research, facilitating comprehensive analyses across a broad spectrum of biological conditions and technological platforms.The corresponding manual gating strategy is summarized in Supplementary Table 2.  valley locations of neighboring samples, i.e., samples with higher protein expression distribution similarity.Such similarity distance between pair of samples is quantified using the earth mover's distance (EMD, calculate emd gene function in the EMDomics R package with default values) 42 based on the ADT count density distribution for each protein marker.

C. Study-level batch correction and broad-level cell type separation quantified by
Landmark Alignment.ADTnorm leverages identified peaks and valleys in ADT density distributions to mitigate technical variations across batches, studies, platforms, and other experimental inconsistencies by aligning these landmarks across samples.This landmark alignment strategy is inspired by methodologies like guassNorm and fdaNorm 25 , initially developed for flow cytometry data.Specifically, ADTnorm utilizes functional data analysis, employing a warping function 27 to perform a one-to-one transformation of ADT expression that uniformly adjusts the ADT density distribution in a monotone fashion.Mathematically, the kernel density estimate for each sample i is represented by a B-spline interpoland x i .The peak(s) and valley(s) detected for each sample serve as landmarks, and the landmark locations are denoted by t ij where j =1,..,m.m is 2, meaning there is only one peak and one valley, and m is 3, indicating that this sample has two peaks and one valley.To align the peaks and valleys across sample, x i is transformed by a strictly monotone and invertible function h i known as a warping function for sample i, such that h i (T start ) = T start where T start is the starting point of the ADT expression value range and h i (T end ) = T end where T end is the ending point of the ADT expression value range.Also, h i (t 0j ) = t ij for j =1,...,m, representing the transformation of the density curves x i so that the corresponding landmark j align to a fixed location t 0j .By default, t 0j is set to the mean value of t ij across samples, but users can pre-defined the target landmark alignment locations (target landmark location parameter in ADTnorm function).To obtain the optimal estimation of h i , the target function is set to minimizing where y is a fixed function in the same class as x i and ω(t) measures the relative curvature of h.
This penalty on the relative curvature ensures that the transformation function is both smooth and monotone.
Note that ADTnorm also allows users to provide prior information to more properly align positive peaks across samples.For instance, in batches exclusively involving T cells (e.g., buus 2021 T), a single positive peak for CD3 protein markers is expected.By providing a list of such batches and markers, ADTnorm can precisely align the detected peak to the positive peaks in other samples, ensuring consistent and accurate peak alignment (Supplementary Note).
This functionality underscores ADTnorm's adaptability and effectiveness in handling various experimental conditions and study designs.ADTnorm can be applied to integrate batch effects across studies (Supplementary Fig. 2) or batch effects between individual samples within studies, e.g., each donor is a batch (Supplementary Fig. 3 and Supplementary Note).Furthermore, by ignoring missing values, ADTnorm can be used to integrate ADT expression for markers profiled in some but not all batches, a capability not shared by all normalization methods (Supplementary Note).

Default and customized ADTnorm normalization settings
In the benchmark analysis with 14 existing methods, ADTnorm normalized the 13 pub-  1B) is available to help users manually fine-tune landmark locations for tailored protein normalization.The customized setting used in the benchmark analysis relied on manually finetuning the peak and valley landmarks to ensure the optimal landmark alignment.
Weighted nearest neighbor integration of the RNA and protein

Robustness evaluation on normalization methods by the imbalanced cell type constitution
To assess the robustness of normalization methods, we filtered the 13 public datasets to create three subsets of the data with different cell-type compositions.In the default integration setting, which we used to illustrate the ADTnorm model and performance, one dataset out of 13 public datasets, i.e., buus 2021 T, was filtered to only contain one sample of 666 T cells.
The other 12 datasets profile total PBMCs.This default setting creates a mild imbalanced scenario for data integration.To test integration performance with moderately imbalanced subset compositions across batches, we kept only T cells in the hao 2020 and triana 2021 studies (24 samples and nine samples, respectively).Furthermore, filtering and only keeping CD8 T cells in the triana 2021 study and T cells from hao 2020 and buus 2021 studies formed the severely imbalanced cell-type composition.We evaluated the normalized expression for the CD19 and CD4 across major cell types on the 10X pbmc 10k and 10X malt 10k datasets, which contain one sample per study and the full data from the original studies were kept.

Stain quality score
To determine the optimal concentration of antibodies to stain specific protein markers, we proposed a stain quality score designed for ADT data.The stain quality score is inspired by the stain index widely used to optimize the quality and effectiveness of fluorescent staining of cells in flow cytometry 43 .The stain index is defined as the ratio of the separation between the positive and negative peaks divided by two times the standard deviation of the negative population.For protein markers with three or more peaks, the stain quality score is positively correlated with the landmark distance between the right-most peak and the negative peak, the sharpness of the most positive peak and the proportion of non-negative populations.The score is negatively correlated with the sum of the standard deviation of each peak.Due to the missing positive peak, for markers with one detected peak, we use the distance between peak and valley as the lower bound of the distance between any positive population and the negative peak mode.We continue to penalize the score for one peak by setting the P osP eakHeight to be 0. The area under the curve of the right tail beyond the valley is used to distinguish markers that only have a negative population and markers with a heavy right tail or even a shoulder peak.In other words, although the independent positive peak failed to be detected, the positive population is still present.

Stain
Stain quality scores are comparable across markers with different peak numbers and generally give higher scores to markers with more peaks.For markers with the same number of identified peaks, better separation of positive and negative populations (longer distance between peak modes) and sharper peaks (lower standard deviation) leads to higher stain quality scores.
Markers with two identified peaks score higher than those exhibiting only a shoulder peak.
Distributions with only one identified peak and a heavy right tail will have a lower score, and distributions with only one peak and no right tail will be given the lowest score.Supplementary Fig. 1C provided the diagram illustrating the peak patterns and associated stain quality score order.

Computational environment for evaluating runtime and memory
Software performance assessments (Supplementary Fig. 4D-E) were conducted on a dedicated server at Fred Hutchinson Cancer Center in terms of running time and memory consumption.The server was equipped with an Intel(R) Xeon(R) Gold 6254 CPU @3.10GHz, featuring 18 cores, 36 threads, and 754GB RAM.For GPU-accelerated tasks, an NVIDIA-SMI GPU with 12GB of VRAM was utilized.The computational environment was hosted on Ubuntu

Figure 1
Figure 1 ADTnorm normalization model, function and performance.A. ADTnorm takes in the ADT expression matrix after routine quality control steps.The normalization procedure starts with the identification of landmarks (peaks and valleys) in the expression density distribution for each protein marker of each batch.Then, detected peaks and valleys are aligned across batches through functional data analysis.The landmark alignment normalization integrates CITE-seq data from different Silhouette score and Adjusted Rand Index (ARI) across various ADT transformation and normalization approaches (Methods).ADTnorm was applied using default parameters or customized landmark alignment adjustments.Gray arrows indicate the direction of improved integration performance, i.e., minimized batch effect and maximized cell type separation.The vertical and horizontal error bars represent the standard deviations of 20 bootstrap samples for each normalization method.D. Violin plots displaying CD19 expression for each cell in the 10X malt 10k dataset following normalization under the severe imbalanced setting (Methods).Abnormal artifacts introduced to specific cell types during the normalization are highlighted by red squares.E. Average auto-gating accuracy across cell types (x-axis) and studies (colors).F. Averaged stain quality quantification across protein markers (x-axis) and studies (colors).The central boxes of D-F represent the interquartile range (IQR), which contains the middle 50% of the data.The line inside the box indicates the median.The whiskers extend to the smallest and largest values within 1.5 times the IQR from the lower and upper quartiles, respectively.B, E and F share the same color legend for studies.

Figure 2
Figure 2 ADTnorm application to antibody titration determination and COVID-19 related disease study.A. ADT expression distributions of three T cell lineage markers (CD3, CD4 and CD8) across samples stained at 1/25, 1/5, 1 and 2 times the commercially recommended antibody concentration following normalization by Arcsinh, CLR or ADTnorm.UMAP displayed the batch correction across the four antibody concentrations and cell-type separation using 124 ADT markers provided by the original paper 17 .B. Stain quality score is utilized to determine the positive population and negative population separation power (Methods).The lowest titration with sufficient separation of positive and negative cells (dashed line indicates stain quality score of 5) is highlighted for each protein marker with increased saturation.C. Data integration across three research institutes where CITE-seq was generated.UMAP shows the batch correction across three research institutes and cell type separation compared across Arcsinh, CLR, DSB and ADTnorm.DSB is the normalization method used in the original paper 13 .UMAPs were constructed on 192 ADT markers colored by research institute or cell type.D. Volcano plots displaying results of differential proportion of the positive cells for each protein marker between healthy donors and COVID-19 Multimodal embeddings were evaluated to test the ADT integration performance of ADTnorm and existing methods.The RNA components are integrated using the Seurat reciprocal PCA (RPCA) strategy.Specifically, the raw gene expression data are first normalized by logtransformation of count per million (log CPM), and the top 5000 feature genes are selected by the "vst" method.Then, the normalized RNA data are scaled using the top features, followed by principal component analysis (PCA) for each study, respectively.Integration anchors are obtained by FindIntegrationAnchors function of Seurat using the RPCA reduction method.We confirmed the RNA component integration performance by visualizing in UMAP and color-coded by batch and cell types in Supplementary Fig.5A.The weighted nearest neighbor (WNN) strategy10 from Seurat is leveraged to further integrate the harmonized RNA and normalized protein components.Specifically, the FindMultiModalNeighbors function from Seurat is used to construct the WNN graph based on the top 30 PCs of the RNA component and the top 15 PCs of the protein component.We use default values for all other parameters in the above-mentioned across-modality integration pipeline.